TENDON REPAIR DEVICE AND METHOD
A surgical device for assisting in the repair and rehabilitation of a tendon, formed of a cylindrical, helically wound braid (similar to a “Chinese finger trap”). The device may be implantable, and configured to enclose the repair site of the severed tendon. As tension or pull is applied to the tendon, the device tightens to secure the repair site. The device may improve mobility and use of the tendon by providing stability to the repair site, improving glide through the tendon sheath, allowing diffusion of nutrients to the repair site, and/or reducing adhesions within the tendon sheath.
The present application claims priority to U.S. Provisional Patent Application Ser. No. 61/505,316, filed Jul. 7, 2011, which is expressly incorporated herein in its entirety.
BACKGROUND OF THE INVENTION1. The Field of the Invention
The present invention relates to a surgical device and method for treating damaged or severed tendons. More specifically, the present invention relates to an implantable device into which the tendon is inserted to facilitate surgical repair, stabilize the repair site, improve rehabilitation of damaged tendons, etc.
2. State of the Art
Tendon injuries are common and occur in a variety of situations including workplace accidents, auto accidents, and kitchen injuries. Tendon injuries cause many associated problems such as pain, reduced mobility, and reduced use of the affected body parts. Thus, it is desirable to treat tendon injuries promptly.
Tendon injuries may require multiple surgeries to correct. Additionally, the surgical process to repair tendons is often tedious and difficult. Flexor tendons may be located within a fibrous tendon sheath. The tendon sheath is highly specialized tissue that is anchored to the bone and is substantially hollow, forming a very smooth, tight “tunnel” around the tendon. It is the tendon sheath that ensures the tendon is in the proper place to effectuate movement at the appropriate joint. The sheath is a continuous tunnel, but also includes a plurality of discrete fibrous segments referred to as pulleys. The pulleys of the tendon sheath ensure the flexor pull of the tendon translates into joint motion. By approximating the tendons close to the bone, the pulleys of the tendon sheath provide a strong mechanical advantage when the joint is flexed, and also prevent bow-stringing of the tendon away from the bones.
When a tendon is lacerated, the proximal end of the tendon often retracts away from the injury site due to the action of muscles on the tendon. The surgeon must find both ends of the tendon, pull the ends through the tight tendon sheath and pulleys, and connect the two ends. Because tendons may be frayed and swollen, it is extremely difficult to manipulate the tendon through the sheath. Even if the surgeon is able to pull the tendon to the appropriate location and repair the laceration, the repair site is often bulky and/or rough. Thus, the repair site will abut the edges of the pulleys, making glide of the repair site through the tendon sheath difficult. Often, with each pass of the tendon through the pulley, abutment of the repair site against the pulley causes damage or irritation to the repair site, delaying the healing process.
Reduced glide of the tendon through the tendon sheath also leads to fibrosis and adhesions around the repair site. Often a second surgery is needed to release the fibrosis and adhesions, in addition to the first tendon repair surgery.
It is believed that early mobility and controlled mechanical strain facilitate healing of the tendon. While stretching can disrupt healing during the initial inflammatory phase, studies have shown that controlled movement of the tendons within the first week following an acute injury can help promote synthesis of collagen by tendon cells, leading to increased tensile strength and diameter of the healed tendons and fewer adhesions compared to tendons that are immobilized. To further show that movement and activity assist in tendon healing, studies have been conducted where the tendons are immobilized after injury, and there has been a negative effect on healing. It is thus desirable to repair a tendon with sufficient strength to allow early mobility, while at the same time, limiting handling of the injured tendon and decreasing operation time.
While movement and some mechanical strain facilitate healing, over-aggressive movement of a tendon after surgery tends to pull the repair site apart, potentially implicating another tendon repair surgery. It can be difficult for patients with tendons healing from repair surgery to effectuate the proper movement and activity to improve healing, while not causing any aggressive movements that might damage the healing tendons. Thus, there is a need for an improved device and method for tendon repair surgery which may allow for early mobilization and mechanical strain while providing support and reducing risk of reinjury to thereby expedite healing of the tendon.
SUMMARY OF THE INVENTIONIt is an object of the present invention to provide a device for facilitating the repair and healing of damaged or severed tendons. It is another object of the present invention to provide a method for facilitating repair and healing of damaged or severed tendons.
In accordance with the principles of the present invention, a tendon repair device and method are disclosed which facilitate movement and healing in a tendon. Because damaged tendons may become frayed and swollen in vivo, and thus difficult to manipulate to a desirable position within the tight tendon sheath, the present invention may facilitate manipulation of the severed tendon through the sheath during surgery.
In accordance with another aspect of the invention, the tendon repair device and method may facilitate early mobilization of the repaired tendon.
According to one aspect of the invention, the device constricts the repair site such that tendon glide within the tight tendon sheath is facilitated.
According to another aspect of the invention, healing may be further facilitated by constructing the device such that nutrients may diffuse in and around the healing tendon while still providing support to the injured portion of the tendon.
According to another aspect of the invention, the device is constructed to at least partially contain the frayed ends of the tendon, thereby decreasing the chance for scar tissue adhesion within the tendon sheath.
According to the present method, the device may be deployed during surgery by inserting each end of a severed tendon into the device such that the two ends meet within the device. When tension is applied to the tendon, the device tightens, thus holding the severed ends of the tendon even more securely and facilitating early mobilization, glide, and reducing adhesions.
These and other aspects of the present invention are realized in the device and method as shown and described in the following figures and related description.
Various embodiments of the present invention are shown and described in reference to the numbered drawings wherein:
It will be appreciated that the drawings are illustrative of various aspects and embodiments of the present invention and not limiting of the scope of the invention which is defined by the appended claims. The embodiments shown accomplish various aspects and objects of the invention, though it is not necessary that any embodiment accomplish all aspects or any particular aspect of the invention. It is appreciated that it is not possible to clearly show each element and aspect of the invention in a single figure, and as such, multiple figures are presented to separately illustrate the various details of the invention in greater clarity. It will be understood that various structures shown in one figure may be used in a device shown in another figure.
DETAILED DESCRIPTIONThe invention and accompanying drawings will now be discussed in reference to the numerals provided therein so as to enable one skilled in the art to practice the present invention. The drawings and descriptions are exemplary of various aspects of the invention and are not intended to narrow the scope of the accompanying claims.
The two ends of the tendon (only one of which is shown in
As shown in
Turning now to
The body of the tendon repair device 10 may be generally cylindrical (or other cross-sectional shape similar to that of a tendon) and has two opposing open ends 20, a length 25, and a radius 28. The tendon repair device 10 may be formed of a helically wound braid, such as a biaxial braid, for example. The braid may be formed from a number of pieces of material which are wound together, or from a single wound piece of material. The material may be selected from a variety of biocompatible materials, including material commonly used for sutures. Depending on the needs, the repair device may be formed from a dissolvable material, such that it will be absorbed by the body after a period of time, or a more permanent material.
In use, the tendon repair device may provide stability to the repair site as it is moved and stretched, because the repair device constricts as it is lengthened. As the tendon repair device 10 is pulled in opposing directions, the length 25 increases and the radius 28 decreases. This effects a reduction in the volume along any given length of the tendon repair device and tightens its engagement with a tendon disposed therein based on the normal behavior of a cylindrical, helically wound braid. Any pulling on the tendon, and thus device, lengthens and narrows the device, thereby providing increased support around the injured portion of the tendon.
At the same time the length 25 of the device is increased, the radial distance between opposing sides and hence the overall circumference and diameter are reduced.
The device may be constructed of different circumferences to accommodate different sized tendons. Preferably, the device would come in a few standard sizes that would cover the range of nearly any tendon. Additionally, specially-sized devices could be made.
Turning now to
The device may be constructed of any suitable biocompatible, surgically implantable material known in the art. For example, the device may be made of a material that is biodegradable, such as those that are currently known in the medical field. This would allow the material to gradually disappear as the tendon heals. The device may also be made of a polymer commonly used as suture material, for example, 4-0 polypropylene, or 4-0 nylon suture material (such as ETHILON®) may be used. Other sizes and materials may be used as well. Additionally, the body of the device may be formed from multiple pieces of polypropylene and/or nylon, which are fused together, or from a single wound piece of suture material.
Turning now to
In either method, the tendon repair device 10 may help to hold the tendon ends 18 together while they heal, and allow portions of the tendon proximal and distal from the injury to bear some of the load when the tendon is placed under mechanical strain. Thus, a patient may be able to move the tendon and place some strain thereon, thereby obtaining the benefits of mechanical strain on the injured tendon with less risk of re-injury.
Turning now to
As the patient works to gain mobility and perform physical therapy for the injured tendon to facilitate healing, the tendon repair device 10 will create further stability for the tendon. Any movement of the patient that tended to pull the repair site 6 apart would cause the device 10 to tighten and stabilize the repair site 6.
Additionally, the device 10 is low-profile, and one of skill in the art would appreciate that as the device tightens, it occupies an even smaller cross sectional area. Because the device 10 contains any frayed ends or bulky repair site, there is a reduction in the frayed ends and/or bulky repair site abutting the edge of a pulley within the tendon sheath. This may increase tendon glide for early mobilization. Furthermore, fibrosis and scar tissue adhesion to the tendon sheath are reduced because the frayed ends of the tendon 18 are located within the device 10. The device is also quickly deployed in surgery, allowing for a shorter operative time, limited exposure, and decreased manipulation of the tendon and sheath.
Additional embodiments of the current device could be used. For example, the device could have a flared end on either one end or both ends. Thus, as shown in
Different configurations may be desired where the surgeon requires additional assistance in threading the severed ends of the tendon through the pulley, or when the severed ends of the tendon are to be joined within a pulley. Likewise, the device could be formed to wrap around a tendon which has been damaged but not completely severed. For example, the device may be split along its length such that a tendon or ligament could be inserted within the device. The device may also be used in settings other than damaged tendons, such as for damaged ligaments, or for attaching a tendon to a bone, etc.
There is thus disclosed an improved device for treating and healing injured tendons. It will be appreciated that numerous changes may be made to the present invention without departing from the scope of the claims.
Claims
1. A device for attaching a two portions of a tendon to one another, the device comprising: an elongated hollow member of woven construction of a biocompatible, surgically implantable material and substantially tubular shape, the member having a first end and a second end, the device being open on the first end and the second end as a first diameter when in a relaxed state, the woven construction being oriented such that pulling longitudinally on opposing ends of the elongated hollow member causes the woven construction to realign and reduce the diameter of the elongate hollow member into a second diameter smaller than the first diameter.
2. A device for assisting in the repair or rehabilitation of a damaged or severed tendon, the device comprising: a body formed from interwoven fibers of a biocompatible, surgically implantable material, the body circumscribing a hollow portion and having an open first, proximal end and an open second, distal end.
3. The device of claim 2, wherein the body formed from interwoven fibers is sized to receive and hold a tendon.
4. The device of claim 2, wherein the body formed from interwoven fibers is sized to receive and hold a ligament.
5. The device according to claim 2, wherein the body forms a flared opening at at least one of the first, proximal end and the second, distal end.
6. The device according to claim 5, wherein the flared opening is formed by a looser weaving of the interwoven fibers at at least one of the first, proximal end and the second, distal end.
7. The device of claim 2, wherein the body is formed from suture material.
8. The device of claim 7, wherein the body is formed from a single piece of suture material.
9. The device of claim 7, wherein the body comprises multiple pieces of suture material fused together at the ends.
10. The device of claim 2, wherein the body formed from interwoven fibers comprises a braid, the body having a radius, and the braid being wound such that pulling on the braid reduces the radius of the body.
11. The device of claim 10, wherein the braid is a cylindrical, helically wound braid.
12. The device of claim 2, wherein the body formed from interwoven fibers further comprises a length, the length extending between the first, proximal end, and the second, distal end, the device being split along the length of the body.
13. A method for treating damaged or severed tendons or ligaments, the method comprising:
- selecting a body formed by a woven generally hollow member having an open first end and an open second end;
- selecting severed ends of a tendon or ligament; and
- advancing the severed tendon or ligament ends into the open end first end and the open second end of the body and securing the body to the tendon or ligament so that the severed ends of the tendon or ligament remain in the body.
14. The method of claim 13, further comprising the step of suturing the body to the tendon or ligament on at least one side of the severed ends.
15. The method of claim 14, wherein the method comprises suturing the body to the tendon or ligament on both sides of the severed ends.
16. The method according to claim 13, wherein selecting a body comprises selecting a woven body with a radius, the body being woven such that pulling on the body causes the body of the radius to reduce.
17. A method of assisting in the repair and healing of damaged or severed tendons or ligaments, the method comprising:
- selecting a body formed by a woven generally hollow member having an open first end and an open second end, the body having a length extending from the open first end to the open second end, the body being split along the length;
- selecting a damaged or severed tendon or ligament; and
- advancing the damaged or severed tendon or ligament into the split along the length of the body and securing the body to the tendon or ligament so that the damaged or severed tendon or ligament remains in the body.
18. The method of claim 17, further comprising the step of suturing the body to the tendon or ligament on at least one side of the severed or damaged tendon or ligament.
19. The method of claim 17, wherein the method comprises suturing the body to the tendon or ligament on both sides of the severed or damaged tendon or ligament.
20. The method according to claim 17, wherein selecting a body comprises selecting a woven body with a radius, the body being woven such that a pulling force along the length of the body causes the body of the radius to reduce.
21. The method according to claim 17, wherein the method further comprises the step of closing the split along the length of the body after the damaged or severed tendon or ligament has been advanced into the body and secured to the body.
22. The method according to claim 17, wherein the selecting a body comprises selecting a woven body comprised of a braid, the body having a radius, and the braid being wound such that pulling on the braid reduces the radius of the body.
23. The method according to claim 22, wherein the selecting a body further comprises selecting a woven body with a weaving that is looser on at least one of the open first end and the open second end, the looser weaving thus forming a flared opening at at least one of the open first end and the open second end.
24. The method according to claim 23, wherein the method further comprises the step of suturing at least one of the open first end and the open second end to a point away
Type: Application
Filed: Jul 3, 2012
Publication Date: Jan 10, 2013
Inventor: Matthew Bills (Provo, UT)
Application Number: 13/541,586
International Classification: A61F 2/08 (20060101);